Eliminating cervical cancer starts with supporting equity

Almost all cases of cervical cancer are caused by HPV, which is largely preventable by a vaccine provided to school-aged boys and girls in Canada.

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In 2018, the World Health Organization (WHO) announced a call to action to bring all countries on the path to eliminate cervical cancer in the next century. Each year, more than 1,300 women in Canada are diagnosed with cervical cancer and over 400 die from the disease, according to the Public Health Agency of Canada. Great progress has been made across the country, but these numbers are nonetheless startling given that this type of cancer is largely preventable and curable when found and treated early.

We know that almost all cases of cervical cancer are caused by the human papillomavirus (HPV), which is largely preventable by a vaccine provided to boys and girls in Canada through school-based immunization programs. We also know that many women who have regular cervical screening have successful outcomes since cervical cancer – when diagnosed and treated at an earlier stage – has a high survival rate. If more people in Canada received the HPV vaccine and had access to and participated in cervical screening followed by immediate care if cancer is detected, we could eliminate this disease.

It’s the goal of the Canadian Partnership Against Cancer (Partnership) to lead partners in designing and delivering an action plan that will allow Canada to be a world leader, meet the WHO call to action and eliminate cervical cancer in Canada by 2040.

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First Nations, Inuit and Métis face barriers in accessing cervical cancer prevention and care, meaning they have a higher incidence of, and worse outcomes, from the disease. This is unacceptable, and as a country, we can do better. The country’s future action plan will deliver measurable results in reducing the burden of cervical cancer for all women in Canada and see this disease eliminated by 2040.

This initiative is an example of how the Partnership is working across Canada with many partners to meet the goals of the country’s Canadian Strategy for Cancer Control 2019-2029, a 10-year roadmap to improve equitable access to world-class cancer care for all people in Canada while focusing on a sustainable health-care system for the future.

The action plan to eliminate cervical cancer is ambitious but achievable. Great strides have already been made to reduce cervical cancer incidence rates over the past few decades. The decline is due to increased access to routine cervical screening for women in Canada within the target age range. Also, in the decade since the HPV vaccine was introduced, incidences of cervical pre-cancers have gone down in those who were vaccinated. Advancements in treatment have also seen a reduction in deaths and improved outcomes for women in Canada diagnosed with cervical cancer.

We are on the path to eliminating cervical cancer, but some people are being left behind. The systems we have built for vaccinating children, the screening programs that require women to travel long distances to a clinic, and the delays some patients experience in accessing treatment after diagnosis, all must be revisited and revised with the benefit of new science, technology and new partnerships. Changes and innovations that benefit those we have not yet reached will drive the action plan.

Not all people in Canada benefit from effective cervical cancer prevention, screening and care

The reality is that, in Canada, HPV vaccination rates are not as high as they could be. Many women do not have access to regular cervical screening with follow-up on abnormal results, and many do not receive high-quality care for cervical cancer.

First Nations, Inuit and Métis women continue to experience poorer outcomes from cervical cancer than non-Indigenous women in Canada, with data indicating that more Indigenous women in Canada are being diagnosed with – and are dying from – cervical cancer. Organized cervical screening programs must be expanded to all regions, including those with large First Nations, Inuit and Métis populations. In these communities, many women living with cervical cancer have reported challenges in accessing effective care, especially culturally safe care, and many have reported significant barriers, such as having to travel long distances for screening, diagnosis and treatment.

Based on the Canadian Cancer Registry, rates of cervical cancer are also higher for those living in rural or remote parts of the country, as well as those with low incomes. Data also show lower cervical screening rates among women in Canada with low incomes, recent immigrants and those who identify as LGBTQ2S+ compared to the rest of the population. These gaps must be measured, monitored and addressed in the action plan if Canada is to meet its target of eliminating cervical cancer in the next 20 years.

An action plan to reduce inequities

The Partnership is currently hosting a stakeholder summit for input into the official Action Plan to Eliminate Cervical Cancer in Canada, which will then be completed and released in the spring. This action plan will set and present targets, priorities and actions to mobilize partners in addressing all aspects of reducing cervical cancer: from prevention efforts anchored in HPV vaccination to effective primary HPV testing and offering self-sampling in cervical screening, timely diagnoses and, finally, the delivery of high-quality treatment and post-treatment care. Most importantly, the Partnership will work tirelessly with partners across Canada to ensure the action plan is put into play. We will also report regularly on our country’s progress.

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The Partnership and all those tasked with responsibilities in the action plan will work with those directly affected by cervical cancer – women, youth at risk, underserviced populations and First Nations, Inuit and Métis governments, organizations and communities – to support implementation of peoples-specific, self-determined actions and to promote culturally safe provision of cervical cancer prevention services, screening and care.

Driving priorities of the Canadian strategy for cancer control

The action plan will achieve key priorities of the Canadian Strategy for Cancer Control 2019-2029, stewarded by the Partnership. This initiative is part of a broader, collective effort to see measurable change in Canada’s cancer system by addressing the strategy’s eight priorities, including: decreasing the risk of people getting cancer; diagnosing cancer at an earlier stage; delivering high-quality, sustainable care for all people in Canada living with cancer; eliminating barriers to people with cancer getting the care they need; and improving supports for patients, families and caregivers.

Three of the eight strategy priorities were co-created with First Nations, Inuit and Métis: access to culturally appropriate cancer care provided closer to home; access to peoples-specific, self-determined care; and First Nations-, Inuit- and Métis-governed research and data systems.

When these efforts are successful in meeting the Canada’s targets, future generations of women in Canada will not develop cervical cancer, and the experience of those living with the disease right now will be improved.

The Canadian Partnership Against Cancer brings together cancer groups and other key partners in the health system to share expertise and build strong networks of change to drive forward the priorities of the Canadian Strategy for Cancer Control 2019-2029. The Partnership is the steward of the strategy and is funded by Health Canada.

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Advertising feature produced by Randall Anthony Communications. The Globe’s editorial department was not involved.